颈椎间盘置换与前路椎间植骨融合修复中年颈椎病:颈椎功能及活动度比较

Cervical disc replacement and anterior interbody fusion in the repair of middle-aged patients with cervical spondylosis: cervical function and range of motion

背景:脊柱非融合技术的发展推动了临近节段及操作节段的关节运动功能保护,在颈椎修复手术中非融合技术目前已经广泛开展。中年颈椎病患者对脊柱关节运动功能的要求较高,采用非融合技术可以提高其预后生活质量,减缓临近节段退变风险。目的:评价在中年颈椎病患者人群中,采用颈椎前路不同植入材料(融合与非融合)治疗单节段椎间盘退变性颈椎病的临床效果。方法:纳入2011年6月至2013年6月收治的采取人工颈椎间盘置换治疗的中年单节段神经根型及脊髓型颈椎病患者10例,并从同期采取前路椎间植骨融合治疗的患者中随机抽取10例作为对照组。治疗前、治疗后1个月、3个月及1年,通过影像学结果观察颈椎活动度变化,采用JOA评分、目测类比评分及颈椎功能障碍指数等指标评估两组患者的修复效果。结果与结论:所有患者均未发现切口脂肪液化、感染及延迟愈合情况,均完成至少1年以上随访。结果显示,治疗后1个月、3个月及1年与治疗前相比均能有效改善JOA评分、目测类比评分(P<0.05),且治疗后两组差异无显著性意义(P>0.05)。然而在颈椎活动度、颈椎功能障碍指数的数据分析中,采用人工颈椎间盘置换非融合治疗组具有明显的优势(P<0.05)。针对中年颈椎病患者,由于其对颈部活动度的生活需求,采用非融合人工颈椎间盘置换的修复方案具有明确的临床优势。

BACKGROUND：The development of spinal non-fusion technology promoted movement function protection of adjacent segment and operating segment. In the treatment of cervical spondylosis surgery, non-fusion technology has been widely carried out. For middle-aged patients with cervical spondylosis, the demand for spinal joint movement function is high. Non-fusion technology can improve the postoperative quality of life and slow down the risk of adjacent segment degeneration. OBJECTIVE：To evaluate the clinical efficacy of anterior cervical different implant materials （fusion or non-fusion） in the treatment of single segment of the intervertebral disc degeneration of cervical spondylosis in middle-aged patients. METHODS：This study enrol ed 10 cases of single segmental radiculopathy and cervical myelopathy after cervical intervertebral disc replacement from June 2011 to June 2013. Simultaneously, 10 cases were randomly selected from patients with anterior interbody fusion as the control group. Before treatment, at 1 and 3 months, and 1 year after treatment, changes in range of motion of cervical vertebra were observed using imaging results. Therapeutic effects were assessed using Japanese Orthopaedic Association Scores, Visual Analog Scale and The Neek Disability Index in both groups. RESULTS AND CONCLUSION：Al patients did not suffer from incision fat liquefaction, infection and delayed healing, and had finished fol ow-up for more than 1 year. Results revealed that Japanese Orthopaedic Association Scores and Visual Analog Scale scores were improved at 1 and 3 months, and 1 year after treatment （P〈0.05）, and no significant difference was detected between the two groups （P〉0.05）. In the analysis of range of motion of cervical vertebra and The Neek Disability Index, there were significant advantages in non-fusion treatment group （P〈0.05）. For middle-aged patients with cervical spondylosis, due to its life demand for neck mobility, the repair program of non-fusion cervical intervertebral disc replacement has a clear advantage.